Abstract
Periodontitis is a prevalent infectious disease worldwide, causing the damage of periodontal support tissues, which can eventually lead to tooth loss. The goal of periodontal treatment is to control the infections and reconstruct the structure and function of periodontal tissues including cementum, periodontal ligament (PDL) fibers, and bone. The regeneration of these three types of tissues, including the re-formation of the oriented PDL fibers to be attached firmly to the new cementum and alveolar bone, remains a major challenge. This article represents the first systematic review on the cutting-edge researches on the regeneration of all three types of periodontal tissues and the simultaneous regeneration of the entire bone-PDL-cementum complex, via stem cells, bio-printing, gene therapy, and layered bio-mimetic technologies. This article primarily includes bone regeneration; PDL regeneration; cementum regeneration; endogenous cell-homing and host-mobilized stem cells; 3D bio-printing and generation of the oriented PDL fibers; gene therapy-based approaches for periodontal regeneration; regenerating the bone-PDL-cementum complex via layered materials and cells. These novel developments in stem cell technology and bioactive and bio-mimetic scaffolds are highly promising to substantially enhance the periodontal regeneration including both hard and soft tissues, with applicability to other therapies in the oral and maxillofacial region.
Highlights
IntroductionPeriodontitis is a widespread infectious oral disease, characterized by irreversible damage in the tooth-supporting tissues, which include the alveolar bone, periodontal ligament (PDL), and
Periodontitis is a widespread infectious oral disease, characterized by irreversible damage in the tooth-supporting tissues, which include the alveolar bone, periodontal ligament (PDL), andCells 2019, 8, 537; doi:10.3390/cells8060537 www.mdpi.com/journal/cellsCells 2019, 8, 537 cementum
The results showed that the transplantation of periodontal ligament stem cells (PDLSCs)-seeded biphasic calcium phosphate scaffold (BCP) promoted effective periodontal regeneration, including new bone formation and PDL with reorganized and reborn collage fibers inserting into adjacent cementum and bone at the right angle, along with abundant blood vessels at 12 weeks
Summary
Periodontitis is a widespread infectious oral disease, characterized by irreversible damage in the tooth-supporting tissues, which include the alveolar bone, periodontal ligament (PDL), and. Challenges remain in regenerating the periodontal apparatus with the formation of the bone-PDL-cementum complex simultaneously [11]. A systematic review is still needed on the new developments in regenerating all three types of periodontal tissues and the simultaneous regeneration of the entire bone-PDL-cementum complex. The present review focuses on the cutting-edge research on periodontal regeneration It includes the mechanisms of regeneration for bone, PDL and cementum; the use of transplanting exogenous stem cells and mobilization of endogenous stem cells from their niches; the development of absorbable, injectable and bio-printed materials; gene therapy and layered biomimetic technologies for bone-PDL-cementum regeneration. The novel developments via stem cells and bio-mimetic scaffolds are promising to substantially enhance the periodontal bone-ligament-cementum regeneration including both hard and soft tissues, with applicability to other therapies in the oral and maxillofacial region
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